Name of your Organization:

Address:

City:

State:

Zip:

Country:

Current website URL:

Current Website Number of Pages:

Number of Pages Envisioned for New Website:

Contact Person for Grant:

Contact Person’s Phone #:

Contact Person’s Email:

Years in Operation:

Location:

Organizational Case Statement (Minimum of 500 characters please):

Why should your organization receive a grant over other nonprofits? (Minimum of 500 characters please):

How can we help you achieve your digital goals:

Agency Gross Annual Operating Budget:

What is your budget for a matching grant?

Complete Digital Want List For Potential Grant(s) Requests, select ALL that apply:

HTML5 Website Design

Web Hosting

Logo Design for Branding

Business Cards

Event Brochures

Tri-Fold Brochures 

Annual Reports

T-Shirt Design

Public awareness campaign management

Postcards

Story Cards

Vehicle Wraps

Billboards

Flyers

Are you applying for:

Matching Grants only Full Grants only Full or Matching Grants

Tax Exempt form information or FED ID#:

Your organizations Charitable status: